The concept of remote control in the medical field for diagnosis and or other operations to be performed by a Doctor on a remote patient is gaining more and more acceptance as it may be used to overcome serious problems of availability particularly in areas of low population insufficient to support locally a doctor having specific expertise. For Example, accurate assessment of abdomen and interpretation of abdominal pain are difficult, particularly for the inexperienced clinician or nurse. Errors and uncertainty can lead to delays in diagnosis and even death, as in appendicitis. These difficulties are amplified for remote patients who may have less timely and unequal access to expert clinical care. Although there is considerable interest and research in palpation technique in telehealth applications, currently there is no system equipped with kinematically similar configurations hand controller and robotic wrist that permits distant clinical palpation. This includes abdominal examination as well as ultrasound diagnosis, which require expert assessment and are a frequent cause of patient transfer.
Haptic controllers and wrists of many different forms have been proposed and used in controlling wrist that may but need not be of similar construction.
With respect to the design of hand controllers or haptic devices for medical procedures, the haptic devices developed by Rosenberg et al. (see U.S. Pat. No. 5,721,5665, 805,140, 6,271,833) and Bevirt et al., U.S. Pat. No. 6,024,576, have all two degrees of freedom providing two rotations about a fixed point (also termed center-of-rotation). They all have simple parallel structures. Additional extra degrees of freedom to these devices will unusually enlarge them or will require the actuators not to be grounded (i.e., become non-floating). Similarly, the force feedback mechanisms by Martin et al., U.S. Pat. No. 6,104,382, and Rosenberg, U.S. Pat. No. 6,154,198, have only two degrees of freedom providing two rotations about a fixed point and use a parallel structure.
The three DoF parallel linkage by Adelstein, U.S. Pat. No. 5,816,105, provides three translational displacements of the end point. The haptic device by Mor, U.S. Pat. No. 6,088,020, has three active and two passive degrees of freedom. It does not have a fixed remote center-of-rotation. The adjustable surgical stand by Faraz et al., shown in U.S. Pat. No. 5,824,007, includes two separate pantographs each providing spherical motion about fixed points. It uses a serial linkage mechanism and the actuators are not grounded.
Birglen et al. in Birglen, L., Gosselin, C., Pouliot, N. (2002), “Shape, a new 3 DoF haptic device”, IEEE Transactions on Robotics and Automation; 18(2) 166–175, reported the development of three degrees of freedom haptic device using a spherical parallel mechanism.
Duriez et al. in Duriez, Ch., Lamy, D., Chaillou, Ch. (2001), “A parallel manipulator as a haptic interface solution for amniocentesis simulation”, proceedings IEEE International Workshop on Robot and Human Interactive Communication, describes the development of a parallel robot for simulating the terminal organ that moves on a spherical surface with variable radius.
The PantoScope by Baumann et al., in Baumann, R., Maeder, W., Glauser, D., Claval, R. (1997), “The PantoScope: a spherical remote center-of-motion parallel manipulator for force reflection”, proceedings IEEE International Conference on Robotics and Automation, describes the use of two non-identical pantograph-like mechanisms to build a parallel, spherical, remote center-of-motion manipulator with force reflecting capabilities. The use of non-symmetrical pantographs, however, works against the uniformity requirement [see paper by Hayward, V. (1995), “Toward a seven axis haptic device”, proceedings IEEE International Conference on Intelligent Robots and Systems], which may degrade the performance of the device.
The six degrees of freedom haptic devices by Lee et al. [see Lee, J. H., Eom, K. S., Yi, B. J., Suh, I. H. (2001), “Design of a new six Dof parallel haptic device”, proceedings IEEE International Conference on Robotics and Automation], and Yoon and Ryu [see Yoon, J., Ryu, J. (2001), “Design, fabrication, and evaluation of a new haptic device using a parallel mechanism”, IEEE/ASME Transactions on Mechatronics 6 (3): 221–230], use non-floating actuators, but to keep the remote center-of-motion at a prescribed location, all degrees of freedom need to be active.
U.S. Pat. Nos. 6,339,969 and 6,368,332 both to Salcudean et al., each discloses a device having several degrees of freedom each employing a plurality of pantographs to control the movement of an end point and one of which has been specifically designed for assisting a surgeon in performing.
With respect to the design of novel robotic wrists, Stanisic et al. in U.S. Pat. No. 6,026,703 and the paper Wiitala, J., Stanisic, M. M. (2000), “Design of an overconstrained and dexterous spherical wrist”, ASME Journal of Mechanical Design. 122: 347–353, describe a wrist structure formed with a dexterous split equator joint device with all points of all links moving on spheres. Thus, there is no remote center-of-motion outside the mechanism.
Compact wrist actuators by Rosheim described in U.S. Pat. Nos. 4,686,866, 4,723,460 and 6,418,811 have three degrees of freedom with linear actuators. These devices provide spherical motion of an end point about a fixed point, which is inside the mechanism. The spherical robotic wrist by Dien et al., U.S. Pat. No. 4,628,765, consists of two perpendicular semi-circular yokes to provide a spherical motion, with no remote center-of-motion. The yokes can be heavy, need precision machining and usually exhibit backlash. The stereotactic apparatus for locating or removing lesions developed by Shelden et al. and described in U.S. Pat. No. 4,638,798, provides the required motions for ultrasounds and palpation. The actuators in this device, however, are floating (i.e., they are placed at the moving joints) making it bulky and heavy.
The wrist for detecting very small breast anomalies by Souluer, U.S. Pat. Nos. 6,192,143; 6,351,549; and 6,400,837, consists of a positioning device, fully adjustable bed and a detection head, which should work together to position/orient the probe over the breast for palpating. The device is not only big, but also cannot provide the required motion for ultrasound diagnosis.
Funda et al., U.S. Pat. No. 6,201,984, developed a remote center-of-motion device for endoscopic surgery. The device provides a spherical motion about a fixed point with two circular guides. Available circular guides are bulky, heavy and difficult to be machined precisely. The actuators are also floating, which would not fulfil the requirements of the wrist design for the purpose of the preferred applications of the present invention.
The remote center-of-motion robot for surgery by Taylor et al., U.S. Pat. No. 5,397,323, has four degrees of freedom and uses a serial linkage mechanism. All the actuators are mounted on the proximal part of the device (not on the ground) and located on the same plane as the work point. Thus, it is not easy to install this device on the implement of a manipulator. The Black Falcon instrument by Madhani et al. described in the paper by Madhani, A. J., Niemeyer, G., Salisbury, K. (1998), “The Black Falcon: a teleoperated surgical instrument for minimally invasive surgery”, proceedings IEEE/RSJ International Conference on Intelligent Robots and Systems, and the Laparoscopic positioning manipulator described in Faraz, A. and Payandeh, Sh. (1998), “A robotic case study: optimal design for laparoscopic positioning stands”, in International Journal of Robotics Research 17 (9): 986–995, have similar structures as the one belonging to Taylor et al. (see U.S. Pat. No. 5,397,323 referred to above).
The laproscopic workstation by Cavusoglu et al. described in Cavusoglu, M. C., Tendick, M. C., Sastry, S. Sh. (1999), “A laparoscopic telesurgical workstation”, IEEE Transactions on Robotics and Automation 15 (4): 728–739, uses three linear actuators with grounded motors (but appear to be coupled) for the first three degrees of freedom and one floating actuator for the fourth degree of freedom.
The parallel mechanism by Vischer and Clavel described in Vischer, P., Clavel, R. (2000), “Argos: A novel 3-DoF parallel wrist mechanism”, International Journal of Robotics Research 19 (1): 5–11, provides three degrees of freedom rotational motion about a fixed working point. However, the remote center-of-motion is enclosed within the mechanism at some configurations. The roll motion is also limited to 120 degrees.
The paper by Hamlin, G. J., Sanderson, A. C. (1994), “A novel concentric multilink spherical joint with parallel robotics applications”, proceedings IEEE International Conference on Robotics and Automation, teaches the use of a pantograph mechanism to built novel spherical joints.
Degoulange et al. [see the paper by Degoulange, E., Urbain, L., Caron, P., Boudet, S., Megnien, J. L., Pierrot, F., Dombre. E. (1998), “HIPROCRATE: an intrinsically safe robot for medical applications”, proceedings IEEE/RSJ International Conference on Intelligent Robots and Systems], reports a device for ultrasound diagnosis; however, all joints are in motion during the tasks. Similarly, Salcudean et al., U.S. Pat. No. 6,425,865 [see also the paper by Zhu, W. H., Salcudean, S. E., Bachmann, S., Abolmaesumi, P. (2000), “Motion /force/image control of a diagnostic ultrasound robot”, proceedings IEEE International Conference on Robotics and Automation, and the paper by Salcudean, S. E., Zhu, W. H., Abolmaesumi, P., Bachmann, S., Lawrence, P. D. (2000), “A robot system for medical ultrasound”, proceedings 9th International Symposium of Robotics Research (ISRR'99)], designed and constructed complete robots for moving ultrasonic probes on the patient's skin with a given force. Accurate palpating of the probe along the roll axis, however, can only be made by the rotation of the entire parallelogram linkage about two perpendicular axes of rotation, and translation of the entire robot over a table. Although the system is counterbalanced and backdrivable, motors are non-floating and the inertial effect of the system is not negligible.
The design by Masuda et al. as described in the paper by Masuda, K., Kimura, E., Tateishi, N., Ishihara, K. (2001), “Three dimensional motion mechanism of ultrasound probe and its application for tele-echography system”, proceedings IEEE/RSJ International Conference on Intelligent Robots and Systems, requires the whole mechanism to sit on patient. As such the workspace is limited. Also, for orienting the probe about a fixed point on the attention skin, all joints need to move.
The wrist by Gourdon et al. described in Gourdon, A., Poignet, Ph., Poisson, G., Vieyres, P., Marche, P. (1999), “A new robotic mechanism for medical application”, proceedings IEEE/ASME International Conference on Advanced Intelligent Mechatronics, uses gears that affects the backdrivability of the system and generates backlash and also have coupled degrees of freedom.
The European ‘OTELO’ project discussed in Guerin, N. S., Bassit, L., Poisson, G., Delgorge, C., Arbeille, Ph., Vieyres, P. (2003), “Clinical validation of mobile patient-expert tele-echography system using ISDN lines”, Proceedings IEEE-EMBS Information Technology Applications in Biomedicine; also in Delgorge et al. (2002) “OTELO project: mObile Tele-Echography using an ultra-Light rObot”, proceedings Telemed'02, describes the development of a four degree-of-freedom wrist with a remote center-of-motion. In their design, in order to produce a single pitch or yaw motion, two degrees of freedom must work cooperatively. Some of the motors are also floating. As a result, the conical workspace is limited. The wrist also has a singular configuration inside its workspace. The European ‘TER’ project described in Gonzales, A. V., et al. (2001). “TER: a system for robotic tele-echography”, proceedings International Conference of Medical Image Computing and Computer Assisted Intervention, describes the development of a robotic tele-echography system that uses parallel configuration based on pneumatic artificial muscles. The system appears to be bulky with limited workspace. Furthermore, the device entirely embraces the patient and there is no reasonable access to the patient in emergency cases.
Mitsubishi et al. as described in Mitsubishi M., Warisawa, Sh., Tsuda, T., Higuchi, T., Koizumi, N., Hashizume, H., Fujiwara, K. (2001), “Remote ultrasound diagnostic system”, proceedings International IEEE Conference on Robotics and Automation, have developed a telerobotic system consisting of circular guides connected in a serial configuration and embedded with gears of high ratios. The mechanism is heavy, large (it has a size of a human trunk) and is therefore not mobile. Also, it does not appear to be backdrivable due to the use of semi circular spur gears moved by small pinions.